Author
Topic: fee schedules (Read 4690 times)

If you can't get the fee schedules on line or from the carrier, one thing I did was to create a spreadsheet for each insurance company. I went over the EOBs and documented the regular allowable amounts. For example, I would look at Aetna's payment EOBs and if I saw 99213 and Aetna allowed $45 on each claim, that was what I entered into the spreadsheet. Doing this I was able to see a particular insurance company had 145 different allowable amounts for 99214. I used to use this info when appealing thei UCR when their EOB said they paid 125% of the medicare allowable. It also helped when they said they didnt pay 100% of our charges and wanted to pay 25%. I may have had 3,000 accounts with the charges at 100% as the allowable. But, this is a suggestion only.

As Sun Tzu once said, in order to defeat your enemy, you have to know your enemy.

Pay_My_Claims

We had to do something similar with BCBS of NC since we are non-par and not able to obtain a fee schedule. Also they only have a few DME codes that are on their fee schedule and being custom rehab we have to submit invoices often. Also it depended on what type of BCBS plan you had as far as the allowables were concerned!!